<div class="widget_wrap">
    <div class="widget_top">
        <span class="h_icon blocks_images"></span>
        <h6>Edicion de sintoma item # <?php echo $this->request->data['Concepto']['id'] ?></h6>
    </div>
    <div class="widget_content">
        <?php echo $this->Form->create('Trauma', array('action' => 'ajaxcargaedit', 'id' => 'formregistrosintoma', 'class' => 'form_container left_label')); ?>
        <?php echo $this->Form->hidden('Concepto.id', array('value' => $this->request->data['Concepto']['id'])) ?>
        <?php echo $this->Form->hidden('Concepto.trauma_id', array('value' => $id)) ?>
        <ul>
            <li>
                <div class="form_grid_12">
                    <label class="field_title" for="name">Sintoma<span class="req">*</span></label>
                    <div class="form_input">
                        <?php echo $this->Form->textarea('Concepto.signo', array('class' => 'text required', 'tabindex' => '1')) ?>
                    </div>
                </div>
            </li>
            <li>
                <div class="form_grid_12">
                    <label class="field_title" for="username">Alerta <span class="req">*</span></label>
                    <div class="form_input">
                        <select data-placeholder="Seleccione la alerta..." class="chzn-select full" name="data[Concepto][alerta_id]" tabindex="4" id="cb_dpto">
                            <option value=""></option>
                            <?php foreach ($alertas as $a): ?>
                                <?php if ($this->request->data['Concepto']['alerta_id'] == $a['Alerta']['id']): ?>
                                    <option value="<?php echo $a['Alerta']['id'] ?>" selected="selected">
                                        <?php echo $a['Alerta']['color'] ?>
                                    </option>
                                <?php else: ?>

                                    <option value="<?php echo $a['Alerta']['id'] ?>">
                                        <?php echo $a['Alerta']['color'] ?>
                                    </option>
                                <?php endif; ?>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
            </li>
            <li>
                <div class="form_grid_12">
                    <label class="field_title" for="username">Tabla score <span class="req">*</span></label>
                    <div class="form_input">
                        <select data-placeholder="Seleccione la tabla de referencia..." class="chzn-select full" name="data[Concepto][scor_id]" tabindex="4" id="cb2">
                            <option value=""></option>
                            <?php foreach ($scors as $a): ?>
                                <option value="<?php echo $a['Scor']['id'] ?>">
                                    <?php echo $a['Scor']['nombre'] ?>
                                </option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
            </li>
            <li>

            </li>

            <li>
                <div class="form_grid_12">
                    <div class="form_input">
                        <button type="submit" class="btn_small btn_blue"><span>Guardar cambios</span></button>
                        </div>
                </div>
            </li>
        </ul>
        </form>
    </div>
</div>
